How is autonomic dysreflexia treated?

Author: SCIRE Community Team | Reviewer: Andrei Krassioukov and Janice Eng | Published: 12 October 2017 | Updated: ~

Autonomic dysreflexia is a medical emergency and needs to be treated immediately. Emergency treatment involves a series of steps to lower blood pressure and remove the cause of the episode. If these steps are unsuccessful, emergency medical treatments are used to try to reduce blood pressure quickly.

• Get into an upright sitting position (or bring your head up) and if possible, lower your legs
• If possible, check your blood pressure and re-check it every 5 minutes
• Loosen tight clothing or devices (including tape, straps, and equipment)
• Search for and remove the cause of the episode:
  • Check for bladder problems
    • If your catheter is kinked or blocked, reposition or flush the catheter
    • If your bladder or collection bag is full, drain
    • If your urine is cloudy or smells bad, it could be a bladder infection – contact a health provider
  • Check for bowel problems
    • If your bowel is full, use your bowel management routine to empty it (such as digital rectal stimulation)
    • Check for other problems like hemorrhoids
• Check for skin problems and remove them if possible (such as ingrown toenails, skin irritation, pressure ulcers, infections, or wounds)
• Check for other problems (such as broken bones)
• Seek medical attention if blood pressure remains high (150 mmHg or above) after following these steps

If blood pressure returns to normal, continue to monitor your symptoms and blood pressure to make sure they do not return and report the incident to a health provider.

This approach is considered to be the most effective first treatment for autonomic dysreflexia. However, although this procedure is commonly used and recommended by health providers, it is supported primarily by expert opinion rather than evidence from research studies.

If the steps above do not reduce blood pressure and it remains high (150 mmHg or above), seek emergency medical attention by calling an ambulance or visiting an emergency department. Emergency medical treatments involve the use of medications that rapidly lower blood pressure. The health providers may also run a series of tests to identify the cause of the episode if one has not been found.

The most commonly used drugs for autonomic dysreflexia are:

• Captopril
• Nifedipine (Adalat, Procardia)
• Nitrates (Nitroglycerine, Depo-Nit, Nitrostat, Nitrol, Nitro-Bid)

However, there is little research evidence to suggest which medications work best for treating autonomic dysreflexia. Speak to your health providers for more information about medications used in autonomic dysreflexia emergencies.